MEDICARE: SUHAIL ADIB KHOURY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME0055732	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110098404	OTHER		RAILROAD MEDICARE
2	77348	OTHER	FL	MEDICARE ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306842620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUHAIL ADIB KHOURY MD

Provider Business Mailing Address
First Line	:	15140 FRUITVILLE RD
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34240-9364
Country	:	US
Telephone Number	:	941-448-5773
Fax Number	:	941-845-4963

Provider Business Practice Location Address
First Line	:	15140 FRUITVILLE RD
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34240
Country	:	US
Telephone Number	:	941-448-5773
Fax Number	:	941-845-4963

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	09/10/2018

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